Ministerial pressure on NHS trusts to cut waiting lists while the health service is being reformed is threatening to undermine improvements in the service, a government watchdog warned yesterday.

Ministerial pressure on NHS trusts to cut waiting lists while the health service is being reformed is threatening to undermine improvements in the service, a government watchdog warned yesterday.

Most people would not have noticed yet but the NHS was getting better, the Commission for Health Improvement said. Although there were new buildings, better equipment and new standards, progress had been "inconsistent".

Presenting its first report on the state of the NHS, based on 270 routine inspections of NHS trusts and 10 investigations into particular problems run over the past three years, the commission said progress was not yet affecting frontline services on a scale to have impressed patients.

"Some parts of the NHS are not improving and may be getting worse," it warned. The upheaval in the NHS and the focus on cutting waiting lists posed particular risks. "NHS leaders are stretched keeping the 'show on the road' now and have limited time for other improvement activities.

"Until the day that improving the quality of NHS care is seen as being as important as finance and waiting times, the temptation for hard-pressed NHS leaders will be to relegate it in their priorities."

Dame Deirdre Hine, who chairs the commission, said: "We do not reach a conclusion that everything is rosy in the NHS but nor do we conclude that it is generally failing. There are trade-offs ..."

A Department of Health spokesman said: "There is much more work to be done to continue the good progress."

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